Inside the Bad Knee and Sick Mind Of the Arthroscopic Surgery Patient

By Rick Skwiot

(First published in PortFolio Weekly)

My first mistake, fueled by youthful enthusiasm, was sprinting up the stadium steps with another lineman on my back. Conditioning, we called it.

My second critical mistake, some three decades later, was going into arthroscopic knee-surgery without the benefit of sedation.

Some might see a masochistic pattern here, but it wasn’t that at all. By now I was a writer. I thought there might be a story in it. For a writer, such thoughts can justify most anything.

Who Is Arthur Skopic?

For years I’d heard sportscasters talk about Arthur Skopic surgery. I figured it was like Tommy John surgery, named for the Dodger pitcher on whom elbow-reconstruction was first performed. Skopic, I guessed, was likely a linebacker for Chicago and maybe a distant cousin of Dick Butkus.

But my knee doctor set me straight. The arthroscope, he explained, contained a camera, light source, and a pathway for fluids. He planned to make incisions in my knee and insert the device, which would send him pictures of my torn cartilage on a TV monitor. Then, guided by this live video, he would stick in other tools to shave away the damaged tissue.

“Let me get this straight,” I said. “You’re going to ram a video camera and an electric shaver into my knee, and I’ll be walking in two days.”

He shrugged like it was nothing special.

“This I’ve got to see.”

Pure Consciousness

In addition to trips up the stadium steps, I’d done deep-knee-bends with two hundred pounds on my shoulders and played years of basketball and tennis on hard courts. For some reason, the left knee kept getting worse.

Finally, this spring, after a week of tennis in Key West, I couldn’t push off on it, merely waving at balls to my backhand. I figured it was time to do something about it.

My MRI (magnetic resonance imaging, where they slide you into a metal tube for forty-five minutes—not recommend for claustrophobics) showed a torn and degenerated meniscus. That’s the cartilage atop your tibia, or shinbone, on which your thighbone, or femur, sits.

Cartilage helps cushion the bones and keeps them from rubbing against one another. That is, if you’ve got enough left after years of abuse and wear. Its absence brings on Arthur Ritis (no relation to Skopic or Butkus), with bone grinding against bone, tenderness, swelling, stiffness, and pain. Not much they can do about that.

I had my pre-op instructions: no aspirin for a week, no alcohol for 24 hours, nothing at all to eat or drink the day of surgery. I showed up at noon feeling pure and slightly hallucinatory from the sensory deprivation.

In the pre-op ward I donned a fetching, baby-blue, split-tail gown. A nurse came in with a purple magic-marker and wrote “NO” on my right kneecap. An anesthesiologist appeared.

I explained that I wanted to remain conscious and alert throughout the operation. Not only did I wish to conduct research for a magazine article, I balked at being knocked-out cold for fear of never waking up. My only experience with general anesthetic (other than tequila and such) had been an unpleasant episode with ether in childhood.

“No problem,” he said. “We’ll just do a spinal without sedation. You’ll be perfectly alert. No problem.”

After that second “No problem,” I looked him up and down. He smiled and slapped my leg like a butcher might a side of beef.

A Knife in the Back

Lying in my immodest gown, I was wheeled on a gurney into an operating room that at looked more like a computer lab: TV monitor, stacks of metal boxes with knobs and digital readouts, wires everywhere. But then the room began to fill with a green-smocked, green-masked, rubber-gloved team: anesthetist, scrub nurse, circulator (an operating-room gopher), surgical assistant, and my knee surgeon.

I scooted onto the operating table and sat hunched forward as instructed. Pods of overhead lights came on.

“This will feel cool,” said the anesthetist.

She swabbed my lower spine with a cold liquid that smelled of alcohol. “Now you’ll sense a pinch and a burning.”

I felt a sting, then heat as she injected some anesthetic just under the skin.

Next she pulled out a syringe with a three-and-half-inch needle that seemed to grow as I stared at it. She placed her hand on my spine. “Now press back against my thumb.”

I sensed the needle sliding deep inside, next to my vertebrae, and wondered if she had, at the last moment, substituted a butcher knife for the syringe. I moaned involuntarily and said:

“You forgot to tell me: ‘Now this will hurt like hell.'”

“You’re feeling pain?”

“Uh, yeah.”

“Where?”

I told her where, good and deep. I felt the needle slide out.

After a moment she said, “Now press back against me again.”

I did, she stabbed me again with the butcher knife and again I moaned.

After three tries I guess I wasn’t looking so good, because the circulator brought a plastic chuck-bucket and set it beside me on the operating table: “Use this if you feel sick.”

I nodded. I did feel something like seasickness coming on, though from the point of view of a speared tuna.

Finally the surgical assistant came over to help. On perhaps the fifth try—I’d lost count in my giddiness—they found what they were probing for and let me lie down.

“You’ll feel a tingling and a numbness move down your legs as the lidocaine takes effect,” the anesthetist said.

The scrub nurse shaved my leg and disinfected it with an iodine-colored solution. The surgical assistant turned on the TV monitor and adjusted the brightness.

My legs were numbing, but we still had some time to kill as the lidocaine did its job. My doctor tossed a roll of adhesive wrap across the operating table, bouncing it off the scrub nurse’s forehead. They all laughed through their surgical masks. He joked with me: “Now that you’re numb from the waist down, I can perform that circumcision you wanted.”

I demurred and thought to ask about an enhancement.

When I could no longer move my toes, everyone got suddenly silent. Lights, camera, action. The circulator handed my doctor a scalpel, and he went to work.

The anesthetist bent close and cooed, “Can you feel anything at all now?”

“Why, yes. As a matter of fact, I can feel the doctor slicing a hole in my leg.”

It hurt but not as bad as a knife in the back.

“Hmm. Well, sometimes these spinals anesthetize unevenly.”

“Truly. That I can sense.”

I tried to raise up to take a look at the scalpel work though couldn’t get a good angle. But soon the cutting phase was over. He’d made two small, bloody holes on the outside of my knee and one on the inside. I lay back and followed my doctor’s gaze to the TV monitor. He had already inserted the quarter-inch-wide arthroscope. But I didn’t feel it. I couldn’t feel a thing from the waist down.

The Four-Letter Word

The surgical assistant and the circulator moved my orange-painted leg north and south, left and right, at my doctor’s instructions, guided by images on the monitor. Once they dropped it down when he wanted it up. He barked, “No!” and they corrected.

On the monitor I could see yellow tissue (chicken fat?) and white tissue—cartilage. Though for all I knew they might have stuck the arthroscope most anywhere. To me it looked surprisingly like the inside of a tuna. Nonetheless, it was eerie watching folks probe around inside me.

My doctor manipulated a hooked surgical tool, testing what parts were intact and what was floating about. I could see the hook on the screen and sense the jolt when it slipped off a rigid target. But I couldn’t feel it.

As he manipulated the arthroscope, images of white shreds—damaged cartilage—came into view. In went the Norelco, or whatever, a tiny, tubular device. A whirling blade shaved off the torn tissue and sucked it away.

The surgical assistant nodded toward the screen and said, “I can see why you had trouble.”

Within a half hour he was sewing me up and injecting marcaine and morphine into the knee.

My doctor leaned forward with the bad news: a split articular cartilage, rough femur, advanced arthritis. No more tennis, ever, unless I was keen on a follow-up knee replacement—an operation that would make this one look like a pinprick. Then he used the four-letter word: golf.

The Sure Cure for Self Pity

The anesthetist wheeled me into the post-op care unit.

“I guess that wasn’t very good news,” she said.

“No, it wasn’t. Oh, well.”

But I couldn’t feel sorry for myself too long. For I was lying in a ward of groaning old women fresh from surgery likely not elective like mine. One cried out in anguish. A nurse went to her and affixed an I.V. She leaned over her patient and said:

“When you want more painkiller, press this button that I’m placing in your hand.”

The old woman, eyes still shut, groaned again and lay motionless.

The nurse looked at her and let out a breath. “Well, even if you can’t hear me I’m telling you anyway: Just press the button when you can’t stand it anymore. Good luck, sweetie.”

Looking at my fellow post-ops, I felt lucky to be alive and conscious and able to play golf if that’s all there was. At that moment, it seemed like a lot. Still, I wanted to get out of there as soon as possible. But they wouldn’t let me go until the numbness went away.

I’d discovered, when I helped lift myself from the operating table back onto the gurney, that my legs felt like dead meat. I tried now to move my toes but couldn’t. Nor could I feel the touch of the blanket on my legs. I thought, if this is what it’s like to be a paraplegic, to have half your body a useless appendage without feel or function,…I looked about for some wood to knock on.

After an hour I could wiggle my toes. When the nurse asked if the numbness had gone, I lied:

“Vanished. I’m ready to go.”

They wheeled me to the outpatient recovery room, where at least people weren’t crying out in pain.

Feeling: Good

Here, after another hour, the numbness finally left my legs. But when I reached beneath the blanket to touch myself, I still had no feeling whatsoever.

I wasn’t exactly panicky, though I wondered if this was normal. However, I was afraid to ask. So my sick mind fixed on the worst-case scenario: Maybe, when the anesthetist was jabbing my spinal column, she clipped a minute nerve, permanently severing all sexual function and feel. I contemplated that at length, in horrific detail.

The recovery-room nurse came by, smiled, and laid a reassuring hand on my blanket. “You’ll be walking out of here in no time.”

I felt it when she patted my foot. But she could have kicked me between the legs and I still would have had the same crooked smile on my face.

Was this my fate: endless rounds of golf and genital road kill? In one afternoon I’d aged forty years. Even a billion-dollar malpractice settlement would be of scant value to me: All I wanted was a Kevorkian machine.

I tried not to touch myself. But I was obsessed. It was like I was fifteen once again—but with a slightly different motivation.

From across the room, a rotund, silver-haired man just back from a colonoscopy tried to engage me in conversation. But my mind was elsewhere: between my legs.

When he eventually looked away I checked once more. Finally I thought I sensed something. Yes, most definitely, yes!

So what if I couldn’t play tennis anymore. There were other pleasures lying in wait along the road of life. This was just another aching step down that road, and, as promised, in two days I was taking it.